Abstract

Introduction

Cytisine is a plant-based drug which has been used routinely across mainland Europe since 1960s with robust evidence of effectiveness and safety. Hajek P, McRobbie H, Myers K Efficacy of cytisine in helping smokers quit: systematic review and meta-analysis Thorax 2013;68:1037-1042.

Cytisine was made available on prescription in the UK on the 22nd Jan 2024. (NCSCT)

University Hospitals of Leicester NHS Trust was one of the first four trusts to gain funding and piloting of Cytisine began from 1st July 2024 across the 3 acute hospital sites.

Methods

A Task & Finish Group was established consisting of the two Acute CURE Clinical Leads, the Project Co-ordinator and CURE Lead Pharmacist.

A decision was made to offer Cytisine to patients during admission and on discharge.

All inpatients referred to CURE were screened by the TDAs for their eligibility prior to a bedside consultation.

The TDAs used the screening criteria document and interrogated the electronic patient’s medical records to determine each patient’s eligibility.

The choice of medication used was patient-led.

All patients were offered NRT for an immediate smoke-free admission and only then was Cytisine offered to complement NRT (which would cease from Day 5 of taking Cytisine).

Patients wishing to take part in the pilot were required to consent to be contacted by the CURE Project Co-ordinator by telephone (or email) to provide feedback on their experience of using Cytisine on days 3, 7 and 28. They also needed to agree to support from the relevant community Stop Smoking Service (SSS) post discharge.

Each patient taking part in the pilot was provided with a physical copy of a patient information leaflet and the dosing guide.

Results :

Of the 1063 patients screened, 279 were eligible (38.1%). The numbers screened were recorded until 30 patients (2.82% of the total number screened) accepted enrolment in the pilot study which ran from July 1st to September 29th. 1 patient withdraw consent and was excluded from the pilot study.

The results from telephone feedback were: of 16 patients who were able to be contacted at Day 28, 11 confirmed they had quit smoking by using Cytisine (38% of pilot cohort of 29). Results combining telephone feedback plus SSS 28 day outcomes showed that 13 patients had quit in total (45% of pilot cohort of 29).

Discussion :

The process of screening for eligible patients was a time-consuming process. After 30 patients had been prescribed Cytisine, TDAs were asked to no longer routinely screen patients. However, Cytisine was still offered to eligible patients who expressed an interest in using the medication to stop smoking.

Patients had successfully quit smoking with very few experiencing side effects. Three patients provided very positive feedback and agreed to their comments being shared in case studies. The pilot was successful in achieving its main aim to prove that Cytisine is a well-tolerated medication, with minimal side effects and high quit rates when commenced during an inpatient stay in tobacco smokers.